Risperidone (Risperdal)

Risperidone (Risperdal) is an atypical antipsychotic prescription medication commonly used to treat mental health symptoms and disorders, such as schizophrenia, symptoms of irritability in autism, and bipolar mania. ^[7] Risperidone is associated with an increased risk of death during treatment in older adults with dementia. Risperidone is not approved for use in elderly patients with dementia-related psychosis. ^[11]

Risperidone brand names

Risperidone is the generic name for the drug, and it is also known as the brand name Risperdal ^[7]

What is Risperidone prescribed for?

Risperidone is approved for treating schizophrenia in adults and children ages 13 and older. It is also approved for acute manic or mixed episodes of bipolar I (in adults, children aged ten and up) and autism-related irritability (in children ten and older). ^[5]

Off-label drug usage occurs when a drug is designed for one condition but has a use for another. Some of the off-label uses for risperidone are: ^[5]

• Borderline personality disorder
• Delusional disorder
• Delirium
• Depression
• Brain injury
• PTSD
• Bipolar disorder
• Conduct disorder
• Lesch-Nyhan
• Tourette’s
• Trichotillomania
• Stuttering
• Movement disorders
• Developmental disorders ^[5]

Risperidone is prescribed along with antidepressants to treat many symptoms and conditions: non-psychotic unipolar depression, autism-related aggression, hyperactivity, social impairment, and cognitive problems, as well as to treat aggression and agitation in dementia patients. ^[5]

How does Risperidone work?

Risperidone is a second-generation (atypical) antipsychotic medication that is thought to work for treating schizophrenia by reducing dopamine. Dopamine is a neurotransmitter (chemical) that signals the brain’s reward area called the mesolimbic pathway. ^[5]

People with schizophrenia have an overactive mesolimbic pathway, so risperidone helps balance that out. ^[5] Dopamine plays a vital role in how the brain works, such as learning, reward, motor function, emotion, and executive functions. ^[4]

How is Risperidone usually taken?

Risperidone can be taken orally, by tablet, in oral solution, or as dissolvable tablets with or without food. It is also available in a long-acting injection form. It is always important to follow your health provider’s directions regarding how to take risperidone. Risperidone dissolvable tables should not be cut or chewed. ^[11]

Your healthcare provider will determine the form of risperidone and the best dose for you based on your health condition, symptoms, symptom severity, health history, and age. ^[5]. Drug dosing varies based on age, the status of the disorder (first-time episode or maintenance therapy), and the type of disorder.

Schizophrenia dosing

Adults 65 and younger

First Episode: First episode dosing starts with 1-3 mg taken orally, divided into one or two doses. Your physician may change and adjust your medication, but the maximum dose is not generally more than 16 mg daily. ^[5]

Maintenance therapy: Maintenance dosing for people 65 years and younger ranges from 1 to 4 mg taken orally, divided into one or two doses. Your doctor may change the dose, but the maximum dose is usually 16 mg or less. ^[5]

Adults 65 and older

First Episode: The starting dose is 0.5 mg, taken orally twice daily. Your physician may adjust your dose as needed. ^[5]

Maintenance therapy: Maintenance therapy doses range from 1 to 4 mg daily, divided into one or two doses. Your physician may adjust your dose, but the maximum dose is 16 mg daily, and doses more than 4 mg daily are generally not more effective. ^[5]

Children 13 to 17 years of age

Dosing starts with 0.5 mg taken orally once daily, either in the morning or at night. Your physician may adjust the dose as needed, but the maximum dose is 6 mg or less daily. ^[5]

Acute manic/mixed bipolar disorder

Adults 65 and younger

Dosing ranges from 1 to 6 mg daily and typically starts with 2 to 3 mg taken each day orally. Your physician may adjust the dose as needed, but the maximum dose is 6 mg or less daily. ^[5]

Adults 65 and older

Dosing starts with 0.5 mg taken orally two times a day. Your physician may adjust your dose as needed, but the maximum dose as needed is generally 6 mg or less daily. ^[5]

Children 10 to 17 years of age

Dosing starts with 0.5 mg taken orally once daily, either in the morning or at night. Your physician may adjust the dose as needed, but the maximum dose is 6 mg or less daily. ^[5]

Tourette syndrome (off-label)

Dosing ranges from 0.2 to 3 mg daily by mouth, taken once or twice daily. The maximum dose is 6 mg daily. ^[5]

How long does Risperidone stay in your system?

Many factors, such as age, weight, metabolism, dose, and use frequency, can impact how long a drug remains in the body. Risperidone remains in the body for 3-6 days in patients receiving oral versions of the medication. ^[11] and 7-8 weeks in patients treated at 25mg or 50 mg injections every two weeks. ^[10]

Risperidone side effects

Medications offer many benefits to improve symptoms of disorders, but side effects are possible. Drugs can affect different people differently, but often the benefits outweigh the possibility of adverse effects, so it is important to discuss options with your physician.

Risperidone can cause a range of mild to severe physical and mental side effects. The most common side effects are ^[11]:

• Drowsiness, sleepiness, or fatigue
• Increased appetite, weight gain
• Indigestion or heartburn
• Nausea or vomiting
• Rhinitis (inflammation in the inside lining of your nose)
• Dry mouth or coughing
• Increased saliva
• Upper respiratory tract infection
• Urinary incontinence
• Constipation
• Heart palpitations
• Fever or rash
• Abdominal pain
• Anxiety, agitation, or restlessness,
• Dizziness or tremors (involuntary shaking, like hands)
• Conjunctivitis
• Pain in extremities or body
• Vision changes, such as blurry vision
• Sexual problems ^[11]:

You may experience one or more of these milder symptoms for a short time after starting risperidone, but after some time, when your body adjusts, they may go away. If symptoms worsen or persist, talk to your physician.

Severe side effects are less common for most patients. Still, older adults with dementia are at increased risk of death if they take risperidone, and patients with certain medical conditions or taking certain medications may have higher risks for more severe side effects, which may include the following:

Severe side effects

• Cerebrovascular events: stroke, transient ischemic attack, vascular malformation, venous thromboembolism ^[5]
• Seizures ^[10]
• Metabolic changes may increase cardiovascular/cerebrovascular risk – hyperglycemia, dyslipidemia, and weight gain.
• Hormonal imbalances: Risperidone may cause hormonal imbalances that can lead to an increase in breast tissue (gynecomastia) ^[3]
• Extrapyramidal symptoms (EPS): EPS can happen when starting a treatment or when dosing is changed. ^[5]
• Acute dystonia: muscle spasms that cause unusual postures, typically of the head and neck. ^[5]
• Akathisia: Feeling restless, pacing. ^[5]
• Tardive dyskinesia (TD): Once someone develops tardive dyskinesia, it is permanent and generally happens with long-term treatment. ^[5] Symptoms include limb, torso, neck, head, tongue, lips, and facial movements.
• Parkinsonian features: Symptoms vary after the medication is stopped. Muscle rigidity, tremors, shuffling gait, and bradykinesia. ^[5]
• Neuroleptic malignant syndrome (NMS): is a life-threatening condition that can cause an altered mental status, fever, “lead pipe” rigidity ^[5], autonomic instability, hypertension, tachypnea, and tachycardia. ^[5]

Risperidone precautions

People with certain health conditions should not take risperidone. Talk to your healthcare provider before starting risperidone if you have any of the following health conditions: ^[11]

• Pregnant or nursing mothers should not breastfeed
• Females and males who plan to have children
• Children or elderly adults
• Kidney or liver impairment
• Parkinson’s disease Lewy Body Dementia
• Low blood pressure (hypotension)
• Tardive dyskinesia
• If you have leukopenia (low white blood cell count) or have a family history of leukopenia.
• Trouble swallowing (Dysphasia)
• Problems regulating body temperature
• Antiemetic effect
• If you have suicidal thoughts or behaviors.
• Metabolic or hemodynamic conditions ^[11]

Neuroleptic Malignant Syndrome (NMS) is a life-threatening reaction to dopamine-antagonist antipsychotic drugs. ^[1] If you or someone taking risperidone shows any of the following symptoms, seek emergency help immediately.

• Fever or shows a change in their mental state
• Stiff or rigid muscles
• Heart symptoms, like a rapid heartbeat
• Changes in blood pressure
• Difficult breathing
• Heavy sweating
• Facial flushing ^[1][9]

Risperidone interactions

Certain medications taken with risperidone may increase the risk of more severe side effects. Be sure to talk to your doctor about any prescriptions or over-the-counter medicines you are taking.

Do not take risperidone if you are allergic to it or paliperidone (a metabolite of risperidone).^[5] Avoid alcohol while taking risperidone. ^[10] Risperidone can interact with other medications. If you take any of the following medications, talk to your healthcare provider before starting risperidone (This is not a complete list, there are others):

• Central Nervous System (CNS) agents: These drugs decrease the effectiveness of risperidone. Opioids taken with risperidone can slow breathing to dangerous levels. There are situations where you may be prescribed risperidone together with a CNS medication. Be cautious operating motor vehicles or activities requiring safety alertness if you are. ^[10]
• Levodopa and Dopamine antagonists: These drugs decrease the effectiveness of risperidone. Opioids taken with risperidone can slow breathing to dangerous levels. There are situations where you may be prescribed risperidone together with a CNS medication. Be cautious operating motor vehicles or activities requiring safety alertness if you are. ^[10]
• Some Antidepressants: Amitriptyline and fluoxetine are two antidepressant drugs that can interact with risperidone. ^[10] These drugs can slow the speed at which your body uses risperidone, which can cause levels of risperidone to build in the body. ^[10]
• Blood Pressure medications: ^[10] Blood pressure medications that lower blood pressure may further decrease blood pressure while taking risperidone, causing blood pressure levels to drop too low. ^[11]
• Cimetidine and Ranitidine: These medications can increase prolactin levels. Prolactin is a hormone in the body responsible for helping to produce breast milk. When prolactin levels are high, it can cause sexual problems, irregular periods, infertility, and unwanted or unwarranted breast milk production in both men and women.
• Methylphenidate: Taking methylphenidate while on risperidone can increase the side effects of risperidone.
• Clozapine: (antipsychotic medication) Clozapine can interfere with how risperidone is metabolized (cleared from the body). ^[10]
• Valproate and Carbamazepine, and other CYP 3A4 Enzyme inducers: These medications can interfere with the way that risperidone breaks down in the body and may interfere with the effectiveness of your medicine as they can make risperidone leave your system faster than it should.

Risperidone storage

Store risperidone tablets, oral solution, and orally disintegrating tablets in a dark, dry place at temperatures 15º-25º C (59º-77º F). Protect from freezing temperatures. ^[11] Keep risperidone in its original pill bottle, with the cap screwed on tightly. Keep in a safe location away from children. Prescription medications should not be shared or given to someone else. Failure to keep drugs away from children and others can cause severe health problems and may be fatal. It is illegal to share or sell medication with others.

You should not flush unused medication or throw it in the trash. You can check with your local pharmacy or health provider’s office about how to safely dispose of unused medicines or for information on drug-take-back programs.

What to do if you overdose on Risperidone

Deliberate or accidental overdose of risperidone can increase the side effects that you experience and cause more serious side effects of the medication.

Symptoms of overdose include ^[10][11]:

• Drowsiness
• Sedation
• Tachycardia
• Hypotension
• Hyponatremia
• Hypokalemia
• Prolonged QT and widened QRS
• Seizures
• Extrapyramidal symptoms (EPS) ^[10][11]

If you accidentally took too much of your medication, contact your healthcare provider or the poison control center (800-222-1222) for additional information.

If someone has collapsed, is unconscious, has a seizure, or has problems breathing after taking risperidone, immediately call 911 for emergency services. Delaying treatment of severe symptoms can cause long-term damage or even death.

Frequently asked questions about risperidone

Does risperidone calm you down?

There is no clear evidence that risperidone will help calm you down. More clinical trials are needed to assess which medications can calm people down and which are the most effective. ^[8] Risperidone is less sedating than other atypical antipsychotics like clozapine, but some research shows that risperidone may increase and improve sleep. ^[6]

Can you take Risperdal for life?

Yes, you can take risperidone for long periods, which may help treat your symptoms, but it will not cure you.

Is risperidone good for anxiety?

Yes, atypical antipsychotics like risperidone can help address anxiety and depressive symptoms in people with schizophrenia, schizoaffective disorders, and other mood and anxiety disorders. ^[2]